Omitting Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer Patients

To describe current research regarding omission of sentinel lymph node biopsy (SLNB) in breast cancer patients.

Results from a recent clinical trial, the SOUND trial, with results pending from trials such as NAUTILUS, INSEMA and BOOG 2013–08, suggest that the omission of SLNB in patients with T1-2 N0 invasive breast cancer is oncologically safe and has noninferior 5-year distant disease-free survival compared to those who underwent SLNB ± ALND. Best practice guidelines do recommend omitting SLNB for older patients with estrogen receptor invasive breast cancers and for most patients undergoing surgery for ductal carcinoma in situ.

Axillary surgery continues to evolve over time to less surgery in the axilla for patients with both invasive and noninvasive disease. Changes in adjuvant therapy, increased use of genomic testing and axillary US have all impacted this trend.